Despite recent reports concerning the relationships between diabetic control and microangiopathy, there still exists only limited knowledge and data on this vital issue and it is imperative that a long-term prospective clinical trial be conducted. Recent technological advances; i.e. home glucose monitoring and insulin infusion devices, as well as patient interest and concern have increased to the point where such a collaborative trial is now feasible. Phase 1 of this clinical trial will force the Principal Investigators to review the entire health care delivery system for the management of chronic illness. Not only must the study design, technical equipment, laboratory results and statistical analysis be addressed but also such vital aspects of health care as patient selection, education, compliance, support, team management, communication systems assessment, and bioethics, etc. This single phase of the study should be sufficiently productive to warrant its funding. Phase 11 will include the randomization of 10 patients into conventional and strict control groups. Conventional therapy will consist of urine glucose measurement, mixed split insulin therapy, dietary prescriptions and visits at 3-month intervals. Strict control will require the use of home glucose monitoring, infusion devices, dietary therapy, an intense patient support and communication system and visits at 1 month intervals. While there is a definite difference in the technology included in the two therapeutic designs, the emphasis on the mode of delivering health care and patient compliance may have the greatest effect on differentiating the two categories. Consequently, patient evaluation, selection, education, as well as the use of contracting, enhanced communications, team care and compliance is stressed in our proposal in addition to the usage of advanced technology. Stereoscopic fundus photographs, HbA(1)C quantitative urine glucose determinations, urinary protein excretion and nerve conduction studies will be used to assess control and therapeutic outcomes.